From the Journals

SGLT2 inhibitor use rising in patients with DKD


 

FROM DIABETES CARE

Future use could approach 80% of DKD patients

Dr. Tuttle estimated that “target” levels of use for SGLT2 inhibitors and for GLP-1 receptor agonists “could reasonably approach 80%” for patients with type 2 diabetes and diabetic kidney disease.

Dr. Katherine R. Tuttle, a nephologist at the Universith of Washington in Spokane

Dr. Katherine R. Tuttle

“We will likely move to combination therapy” with simultaneous use of agents from both classes in a targeted way using “precision phenotyping based on clinical characteristics, and eventually perhaps by biomarkers, kidney biopsies, or both.” Combined treatment with both an SGLT2 inhibitor and a GLP-1 receptor agonist may be especially suited to patients with type 2 diabetes, atherosclerotic cardiovascular disease, low estimated glomerular filtration rate, and need for better glycemic control and weight loss, a profile that is “pretty typical” in real-world practice, said Dr. Tuttle, a nephrologist and endocrinologist and executive director for research at Providence Healthcare in Spokane, Wash.

Study included patients with commercial or Medicare Advantage coverage

The study used information in an Optum database that included patients enrolled in either commercial or in Medicare Advantage health insurance plans from 2013 to the first quarter of 2020. This included 160,489 adults with type 2 diabetes and DKD who started during that period at least one agent from any of the seven included drug classes.

This focus may have biased the findings because, overall, U.S. coverage of the relatively expensive agents from the SGLT2 inhibitor and GLP-1 receptor agonist classes has often been problematic.

“There are issues of cost, coverage, and access” using these medications, as well as limited data on cost-effectiveness, Dr. Paik acknowledged. Additional issues that have helped generate prescribing lags include concerns about possible adverse effects, low familiarity by providers with these drugs early on, and limited trial experience using them in older patients. The process of clinicians growing more comfortable prescribing these new agents has depended on their “working through the evidence,” she explained.

The FDA’s approval in July 2021 of finerenone (Kerendia) for treating patients with type 2 diabetes and chronic kidney disease threw yet another new variable into the prescribing mix for these patients.

“SGLT2 inhibitors are here to stay as a new standard of care for patients with diabetic kidney disease, but combination with finerenone might be especially useful for patients with diabetic kidney disease and heart failure,” Dr. Tuttle suggested. A new generation of clinical trials will likely soon launch to test these combinations, she predicted.

Dr. Paik had no disclosures. Dr. Tuttle has been a consultant to AstraZeneca, Bayer, Boehringer Ingelheim, Gilead, Goldfinch Bio, Eli Lilly, and Novo Nordisk.

Pages

Recommended Reading

Most kids with type 1 diabetes and COVID-19 in U.S. fared well
The Hospitalist
In-hospital glucose management program gives dramatic savings
The Hospitalist
Dapagliflozin misses as treatment for COVID-19 but leaves intriguing signal for benefit
The Hospitalist
FIDELIO-DKD: Finerenone cuts new-onset AFib in patients with type 2 diabetes and CKD
The Hospitalist
Sotagliflozin’s HFpEF benefit confirmed by new analyses
The Hospitalist
Sotagliflozin use in T2D patients linked with posthospitalization benefits in analysis
The Hospitalist
Unmanaged diabetes, high blood glucose tied to COVID-19 severity
The Hospitalist
ESC heart failure guideline to integrate bounty of new meds
The Hospitalist
Patients with diabetes more likely to be hospitalized, especially with foot infection
The Hospitalist
Empagliflozin gets HFrEF approval from FDA
The Hospitalist
   Comments ()